Does Medicare Cover Home Health Care and Home Aides?

What Medicare Home Health Care Actually Is

Home health care under Medicare means skilled medical services delivered in your home when you’re recovering from an illness, injury, or surgery, or managing a condition that needs professional attention. It isn’t the same as “home care” in the everyday sense of someone coming over to help around the house. Medicare uses the term in a specific way, and the rules follow from that definition.

The benefit is part of both Part A and Part B, depending on the circumstances, and it’s available to people in Original Medicare and, in a different administrative form, through Medicare Advantage. Coverage is not limited to a set number of visits. As long as you continue to meet the requirements, you can continue to receive care. In practice, though, the care is meant to be intermittent and tied to a medical goal such as healing a wound, regaining mobility after a hip replacement, or learning to manage a new medication regimen.

The Four Requirements to Qualify

To get Medicare-covered home health care, you generally have to meet all of the following conditions:

• You’re under the care of a doctor, and you’re getting services under a plan of care. A physician or an allowed practitioner establishes the plan and reviews it regularly. The plan lists what services you need and how often.
• A doctor certifies that you need skilled services. That means intermittent skilled nursing care, physical therapy, speech-language pathology, or a continuing need for occupational therapy. Needing only help with daily activities doesn’t count.
• A doctor certifies that you’re homebound. More on this below, because it’s the requirement people misunderstand most.
• The home health agency is Medicare-certified. If you use an agency that doesn’t participate in Medicare, the benefit doesn’t apply.

There’s also a documentation step. Medicare requires that a face-to-face visit with a physician or other allowed practitioner, related to the main reason you need home health, takes place within a window around the start of care, generally within the 90 days before or the 30 days after home health begins. If you’ve just left the hospital, the hospital stay can sometimes serve that purpose, and the discharge team often arranges the referral. If you’re at home and your condition is declining, the first step is usually a conversation with your own doctor.

What “Homebound” Means

Many people hear “homebound” and picture someone who never leaves the house. Medicare’s definition is more flexible, but it is also more specific than you’d guess. Generally, both of these need to be true:

• You need the help of a cane, wheelchair, walker, or crutches, special transportation, or another person to leave home, or your doctor believes that leaving home could be harmful to your health or make your condition worse.
• You normally can’t leave home, and leaving takes considerable and taxing effort.

You can still be considered homebound if you leave for medical appointments, adult day care, or religious services. Occasional, short, infrequent outings, such as a trip to a barber, a walk around the block, or a family event, don’t necessarily disqualify you. What matters is the overall picture: leaving home is the exception, not the routine, and it requires real effort or support.

This is a clinical judgment recorded in your medical file, which is why it matters that your doctor understands how hard it actually is for you to get around. If you downplay your difficulties at an appointment, the documentation may not support the certification.

Home Health Coverage at a Glance

Type of help	Covered by Medicare?	Notes
Part-time skilled nursing	Yes	Must be ordered by your doctor and certified
Physical, occupational and speech therapy	Yes	Must be part of a plan of care
Home health aide	Only alongside skilled care	Part-time only
Round-the-clock care	No	Paid privately or through other programs
Bathing, dressing and housekeeping alone	No	Considered custodial care

What Medicare Covers at Home

When you qualify, Medicare covers the following services in your home:

• Skilled nursing care on a part-time or intermittent basis, such as wound care, injections, catheter care, or monitoring a complex condition.
• Physical therapy, occupational therapy, and speech-language pathology to restore function.
• Medical social services, which can help with the social and emotional side of an illness and with connecting you to community resources.
• Home health aide services, such as help with bathing or dressing, but only on a part-time basis and only while you’re also getting skilled care.
• Medical supplies used in your care, such as wound dressings.
• Durable medical equipment, such as walkers, wheelchairs, and hospital beds, when medically necessary and ordered by your doctor.

The aide benefit is the one that causes the most confusion. Medicare will pay for a home health aide, but only as a supporting service alongside skilled care. Once the skilled need ends, the aide coverage ends with it, even if you still need help with bathing.

What Medicare Doesn’t Cover

Medicare doesn’t cover:

• 24-hour care at home. The benefit is part-time or intermittent. Generally that means combined skilled nursing and aide services of fewer than eight hours a day and 28 or fewer hours a week, though in some cases up to 35 hours a week can be allowed.
• Custodial or personal care when it’s the only care you need. Help with bathing, dressing, eating, toileting, and getting around is considered custodial care, and Original Medicare doesn’t pay for it by itself.
• Homemaker services. Cleaning, laundry, shopping, and cooking are not covered when they’re the only help required.
• Meal delivery. Medicare doesn’t pay for home-delivered meals, though some programs and some Advantage plans do.

This is the central point of the whole subject. Medicare is designed to pay for medical care, not for long-term support. If what your family member needs is someone to help them get through the day safely, that’s a long-term care need, and it’s paid for in other ways. We explain those in our guide to Medicare and long-term care.

What You’ll Pay

For covered home health services, you generally pay nothing. That’s the part that makes the benefit valuable. For durable medical equipment, you typically pay 20% of the Medicare-approved amount, and the Part B deductible, which is $283, applies. A Medigap plan can cover that 20%; Plans G and N are two common examples.

If you don’t meet the homebound or skilled-need requirements, or if you want more hours than Medicare allows, you pay for the additional help privately. Agencies set their own hourly rates, and costs vary widely based on location and the type of caregiver, so get quotes from several local agencies and ask what’s included. Our article on what a major health event can cost helps put those numbers in context.

Home Health vs. a Skilled Nursing Facility

After a hospital stay, you may be offered a choice between going home with home health services or going to a skilled nursing facility for rehab. They’re different benefits with different rules. A skilled nursing facility stay generally follows a qualifying inpatient hospital stay of at least three days, and after the first 20 days you pay a daily coinsurance, which is $217 per day for days 21 through 100. Home health has no such hospital-stay requirement and no coinsurance for covered services.

Neither is automatically better. Rehab in a facility offers more intensive daily therapy and supervision. Home offers comfort and familiarity, and works best when there’s a family member or friend nearby who can help with the parts Medicare doesn’t cover. When a hospital discharge planner asks you to choose, ask what the therapy schedule would look like in each setting and who will provide the non-medical help. Our guide to Medicare for caregivers goes into the discharge conversation in more detail.

How to Get Started

The process is more straightforward than it sounds:

• Talk with your doctor. Describe what’s going on at home and how hard it is to leave the house. If home health would help, your doctor can refer you.
• Choose a Medicare-certified agency. Medicare’s Care Compare tool lists agencies in your area with quality ratings. If you’re coming from a hospital, the discharge planner will often give you a list, and you generally have the right to choose.
• Expect an assessment. A nurse or therapist visits to evaluate you and set up the plan of care with your doctor.
• Expect reviews. Your care is reviewed regularly, and your doctor needs to recertify the need for services as time goes on. If you improve and no longer need skilled care, the services end.
• Expect extra paperwork in Ohio. Ohio is one of several states where home health agencies billing Original Medicare take part in a CMS program called the Review Choice Demonstration, in which the agency’s documentation is reviewed, either before or after claims are paid. CMS says the program should have minimal effect on beneficiaries and it doesn’t apply to Medicare Advantage, but it’s one more reason your doctor’s notes and the agency’s records need to clearly support your need for care.

If an agency tells you that Medicare won’t cover something, you can ask for the decision in writing and appeal. Our post on Medicare fraud and scams is also worth a glance, because home health is an area where legitimate agencies are the norm but bad actors do exist. Be cautious of anyone who offers free services in exchange for your Medicare number.

Medicare Advantage and Home Health

Medicare Advantage plans must cover home health care at least to the same extent as Original Medicare, but the way you access it can differ. Many plans require you to use agencies in their network, and some require prior authorization before services begin or continue. Check those rules before you need care, not after.

Advantage plans may also add benefits that Original Medicare doesn’t have. Some offer a limited number of hours of in-home support, meal delivery after a hospital stay, or transportation to appointments. These extras vary and are often limited by duration or eligibility, so read the plan’s Evidence of Coverage rather than relying on a summary. We cover how the two paths compare in our overview of Medicare Advantage plans.

When You Need More Than Medicare Provides

If your family member needs help beyond what Medicare will pay for, there are other places to turn:

• Medicaid: Ohio has a Medicaid waiver program called PASSPORT that helps eligible older adults receive care at home instead of moving to a nursing facility. Eligibility is based on age (60 or older), financial criteria for Medicaid, and needing a nursing-facility level of care, so contact your local Area Agency on Aging to ask. In southwest Ohio, that’s the Council on Aging of Southwestern Ohio.
• Long-term care insurance: A policy purchased in advance can pay for home care, assisted living, or nursing facility care. It generally has to be bought while you’re healthy. We explain how it works on our long-term care insurance page.
• Short-term care options: Some shorter policies cover a limited period of home care and are underwritten more simply. See our pages on short-term care insurance and short-term home care for how they differ.
• Veterans’ benefits: The VA has programs that can help eligible veterans pay for in-home help. Your county Veterans Service Office can tell you what you may qualify for. We’re an independent agency, not affiliated with the VA, TRICARE, or the Department of Defense, so confirm eligibility with them directly.
• Paying privately and family support: Many families blend paid help with family caregiving. Be realistic about the schedule and about who is doing what.

Frequently Asked Questions

Does Medicare pay for a home health aide?

Only part-time, and only when you’re also receiving skilled care such as nursing or therapy. Medicare doesn’t pay for a home health aide as a stand-alone service.

How much does Medicare home health care cost?

For covered home health services, you generally pay nothing. For durable medical equipment you typically pay 20% of the approved amount, and the Part B deductible applies.

What does homebound mean for Medicare?

You need help, a device, or special transportation to leave home, or leaving is medically inadvisable, and leaving takes considerable and taxing effort. Occasional short outings and medical appointments don’t automatically disqualify you.

Does Medicare cover 24-hour care at home?

No. Medicare covers part-time or intermittent care. Round-the-clock care at home is generally a private cost unless another program, such as Medicaid or long-term care insurance, applies.

Does Medicare cover home care for dementia?

Medicare covers skilled services at home if you meet the requirements, but it doesn’t pay for the ongoing supervision and personal care that dementia often requires. Those costs are typically paid through other sources.

Do I need a hospital stay to qualify?

No. Home health doesn’t require a prior hospital stay, though many people start it after one. You do need a doctor’s referral and certification.